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Emery, Karen S. . . . _ . 3 I,- , . NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Karen S Emery. Female Date of Death Age If Veteran of U.S.Armed Forces, 04/13/2021 67 Years War or Dates ZPlace of Death Hospital,Institution or W City,Town or Villager Corinth Town Street Address 18 Emery Lane,Corinth Town,New York 12822 to Manner of Death ©Natural Cause El Accident El Homicide El Suicide 0 Undetermined El Pending LU O Circumstances Investigation LU Medical Certifier Name Title • 0 John Delmonte MD Address 3 Care Lane,Saratoga Springs,New York 12866 Death Certificate Fited District Number Register Number City,Town or Village Corinth 4553 10 Li Burial Date Cemetery,Crematory or Facility Name 04/14/2021 Pineview Crematory ❑Entombment Address ©Cremation Queensbury Town,New York Donation Z ❑Removal Date Place Removed h and/or and/or Held N � Hold Address U) ❑Transportation Date Point of ' b by Common Shipment Carrier Destination EiDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom ▪ Remains are Shipped,If Other than Above "S Address CC U,I a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/14/2021 Registrar of Vital Statistics Brenda L Penis(Electronically Signed) (signature) District Number 4553 Place Corinth, New York I certify that the remains of the decedent identified above were disposed of in accordance with this per • on: IF A 'ZDate of Disposition -u1,jq 1ZJ Place of Disposition 'titIL tv.--- LU _, (address) W (section) /!ot number) (grave number) CCS Name of Sexton or Person in Charge of Prem. es J ��^^"ti�� Z �^ (p/ print) ..ez ee W Si (nature Ttle a 0��t2 g DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) — . .... 1471 i ... Receipt ,. Human remains of / delivered on ' ' t'i- , 20 . , . . „ _ ,........_ Pine View CeeMetery Represent*the funeral home named on burial pe , Official Funeral Directors Reg.or License#